Empirical vs. Susceptibility-Guided Treatment of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis

Nyssen, Olga P.; Espada, Marta; Gisbert, Javier P.

doi:10.3389/fmicb.2022.913436

Cited by 34 publications

(38 citation statements)

References 122 publications

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“…Some authors have demonstrated higher eradication rates with culture-guided therapy compared to empirical treatment (26-28), showing tailored therapy to be the most cost-effective strategy (28, 29). Nyssen et al for rst-line treatments also obtained better e cacy results with susceptibility-guided strategy, but this bene t could not be demonstrated when quadruple regimens were prescribed (30). It is important to consider the risks of prescribing empirical quadruple treatments in selecting resistant H. pylori strains and in their impact on gut microbiota.…”

Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Helicobacter pylori Primary and Secondary Antimicrobial Resistance through 22 Years of Culture Experience (2000-2021)

Arbulo

Tamayo

Bujanda

et al. 2022

Preprint

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Background Helicobacter pylori gastritis is considered to be an infectious disease, irrespective of an individual’s symptoms and stage of disease. Until now, most consensus recommendations were based on empirical treatments conditional on local antimicrobial susceptibility patterns. The aim of this study was to provide information about the primary and secondary antimicrobial resistance rates in Gipuzkoa, Basque Country, Spain, and to share the experience of H. pylori culture followed by susceptibility testing. Methods In total, 31,406 gastroduodenal biopsies and 2,641 string tests from patients over the age of 15 were plated on selective media, isolating H. pylori in 36.7% of biopsies and 50.7% of string tests. Antibiograms could be performed in 96.6% (12,399/12,835) of H pylori isolates. Overall, 10.8% (1,343/12,399) of antibiograms were obtained from second or subsequent samples from the same patient. PCRs were also used to detect H. pylori and its clarithromycin resistance. Results Primary resistance to amoxicillin and tetracycline was unusual, 0.6% and 0.2%, respectively. Primary resistances to clarithromycin and metronidazole remained constant through the 22-years of study, around 14% and 30% respectively. Primary resistance to levofloxacin tripled from 7.6% in 2000 to 21.7% in 2021 (p < 0.001) and grew with patient’s increasing age. Simultaneous resistance to clarithromycin, metronidazole and levofloxacin was 1.8%. Secondary resistance to all antimicrobials was significantly higher than primary resistance. Conclusion We encourage Microbiology laboratories to perform culture and/or PCR of H. pylori followed by antimicrobial susceptibility testing, allowing physicians to follow a tailored treatment strategy.

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Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Helicobacter pylori Primary and Secondary Antimicrobial Resistance through 22 Years of Culture Experience (2000-2021)

Arbulo

Tamayo

Bujanda

et al. 2022

Preprint

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“…115 A recent meta-analysis combined 54 clinical studies to examine the efficacy of tailored therapy as first-and second-line therapy. 116 In this study, tailored therapy had a significantly higher eradication success rate than that of empirical therapy in an integrated analysis that included all eradication regimens (86% vs 76%: RR, 1.12; 95% CI, 1.08 to 1.17). However, there were no differences within the group of primary treatments, and no differences within the group of secondary treatments.…”

Section: Clinical Outcomes Of Tailored Therapymentioning

confidence: 68%

Optimizing Helicobacter pylori Treatment: An Updated Review of Empirical and Susceptibility Test-Based Treatments

et al. 2023

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As the rate of discovery of drug-resistant Helicobacter pylori cases increases worldwide, the relevant societies have updated their guidelines for primary eradication regimens. A promising strategy against drug-resistant H. pylori is tailored therapy based on the results of an antibiotic susceptibility test; however, it is difficult to apply this strategy to all cases. Although culture-based antibiotic susceptibility tests can assess resistance to any antimicrobial agent, their greatest disadvantage is the time required to draw a conclusion. In contrast, molecular-based methods, such as polymerase chain reaction, can rapidly determine the presence of resistance, although a single test can only test for one type of antimicrobial agent. Additionally, the limited availability of facilities for molecular-based methods has hindered their widespread use. Therefore, low-cost, minimally invasive, simple, and effective primary regimens are needed. Several studies have compared the efficacy of the latest primary eradication regimens against that of tailored therapies, and their results have shaped guidelines. This article reviews the latest research on empirical and tailored treatments for H. pylori infections. Evidence for the superiority of tailored therapy over empirical therapy is still limited and varies by region and treatment regimen. A network meta-analysis comparing different empirical treatment regimens showed that vonoprazan triple therapy provides a superior eradication effect. Recently, favorable results towards vonoprazan dual therapy have been reported, as it reached eradication levels similar to those of vonoprazan triple therapy. Both vonoprazan dual therapy and tailored therapy based on antibiotic susceptibility tests could contribute to future treatment strategies.

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“…Two meta-analyses have shown a benefit in increasing eradication rates when susceptibility-guided treatment was performed [ 36 , 37 ]. However, both demonstrated that better efficacy results occurred only among patients in whom the susceptibility-guided strategy, as opposed to empiric therapy, was implemented for first-line triple regimens—combinations that are no longer considered an ideal empiric regimen.…”

Section: The Role Of Antimicrobial Susceptibility Testing In Clinical...mentioning

confidence: 99%

“…A recent comprehensive meta-analysis reviewed 16 studies (with a total of 1283 patients) of tailored versus empiric therapy for refractory infection [ 36 ]. Most studies were of second-line therapy, and nine of them were randomized.…”

Section: The Role Of Antimicrobial Susceptibility Testing In Clinical...mentioning

confidence: 99%

Clinical Implication of Drug Resistance for H. pylori Management

Argueta

Elfanagely

et al. 2022

Antibiotics

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Rates of antimicrobial-resistance among H. pylori strains are increasing worldwide, resulting in declining eradication rates with current therapies, especially those containing clarithromycin or levofloxacin. To improve H. pylori management, a paradigm shift is needed, from the empiric approaches formerly employed, to regimen selection based upon knowledge of local and patient-level antimicrobial susceptibility data. We review the mechanisms of H. pylori antimicrobial resistance and the available worldwide pattern of resistance to key antimicrobials used in H. pylori therapy. The practicalities and challenges of measuring susceptibility in clinical practice is discussed, including not only conventional culture-based techniques but also novel sequencing-based methods performed on gastric tissue and stool samples. Though clinical trials of “tailored” (susceptibility-based) treatments have yet to show the clear superiority of tailored over empiric regimen selection, the ability to measure and modify treatment based upon antimicrobial susceptibility testing is likely to become more frequent in clinical practice and should lead to improved H. pylori management in the near future.

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Empirical vs. Susceptibility-Guided Treatment of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis

Cited by 34 publications

References 122 publications

WITHDRAWN: Helicobacter pylori Primary and Secondary Antimicrobial Resistance through 22 Years of Culture Experience (2000-2021)

WITHDRAWN: Helicobacter pylori Primary and Secondary Antimicrobial Resistance through 22 Years of Culture Experience (2000-2021)

Optimizing Helicobacter pylori Treatment: An Updated Review of Empirical and Susceptibility Test-Based Treatments

Clinical Implication of Drug Resistance for H. pylori Management

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